New strategy to restore erectile function after radical prostatectomy novel minimally invasive end-toside sural nerve grafting procedure.

Abstract

Introduction and Objectives: We assessed the potential of innovative nerve grafting surgery to restore erectile function, and improve sexual QoL in men with erectile dysfunction after nerve-, and nonnerve- sparing radical prostatectomy. Method(s): In a retrospective chart review, medical records were abstracted for men who had novel penile reinnervation surgery between 5th March 2015, and May 18th 2017, were < 70 years, and had low comorbidity burden. Novel surgery involved bilateral end-to-side somatic-toautonomic sural nerve grafts from the femoral nerve to the penile corpora cavernosa, with a judicious partial fascicular neurotomy of the femoral nerve. Erectile function, and sexual QoL outcomes were serially assessed using the International Index of Erectile Function (IIEF-5), and sexual domain of the Expanded Prostate Cancer Index Composite (EPIC-26), respectively. The proportion, and corresponding 95% confidence intervals of men with clinically significant outcomes after nerve grafting compared with prior to nerve grafting were determined. Result(s): Prior to nerve grafting surgery, all patients were impotent following their radical prostatectomy. The median age of men at nerve grafting was 64 years (range, 49- 69). The median time between nerve-, and non-nerve-sparing radical prostatectomy, and novel nerve grafting surgery was 2.4 years (range, 1.8-4.3 years), and 2.2 years (range, 0.3-12.9), respectively. Median follow-up was 18 months (range, 12-36). At 12 months post-nerve grafting, 71% (95% CI 44% to 90%) of patients had erectile function recovery sufficient for satisfactory sexual intercourse. In men with restored erectile function, 100% (95% CI 74% to 100%), and 83% (95% CI 52% to 98%) had clinically significant improvements in sexual function, and reduced bother, respectively. Table 3 Proportions of clinically relevant outcomes at 12 months post-nerve grafting compared with pre-nerve grafting. aProportions, and corresponding 95% confidence intervals were calculated using the exact method of Clopper and Pearson.30 (Table presented) Conclusion(s): Innovative minimally invasive end-to-side sural nerve grafting has the potential can restore erectile function, and improve sexual QoL in men with erectile dysfunction following nerve-, or non-nerve-sparing radical prostatectomy.